Bangladesh's healthcare is a mess. How can the government clean it up?

Over the past two weeks, there has been a heated dispute across the country between Medical Assistant Training School (MATS) students and medical college students over who gets to call themselves a "doctor".

The Medical Assistant Training School (MATS) students argue that their four-year diploma, registration with the Bangladesh Medical and Dental Council (BMDC), and authorisation to prescribe certain medications qualify them as "diploma doctors". 

But students pursuing the Bachelor of Medicine, Bachelor of Surgery (MBBS) and the Bachelor of Dental Surgery (BDS) strongly oppose this designation, arguing that the title of "doctor" should be reserved exclusively for them to prevent public confusion and mitigate potential medical risks.

MATS students protest at National Press Club, Dhaka on 10 February 2025. File Photo: Focus Bangla

This conflict has paralysed parts of the healthcare sector, with MATS students shutting down academic activities since 3 March, awaiting a court verdict on 12 March that will decide who rightfully holds the title.

Intern doctors and medical students had also been on strike since 23 February, pushing for demands like stricter control over over-the-counter (OTC) drug prescriptions, the hiring of 10,000 doctors for vacant posts, and raising the BCS medical recruitment age limit.

They also demanded MATS institutions and low-quality medical colleges shut down and better legal protection against violence and harassment. 

Postgraduate trainees joined them later with an indefinite work stoppage, though it was later paused until 12 March.

These protests are just the latest in a series of movements and unrest that have rocked the healthcare sector since Sheikh Hasina was ousted on 5 August last year. 

For example, on 1 September, doctors from both government and private hospitals went on an indefinite strike after allegations of medical negligence in the treatment of a private university student, who reportedly died due to improper care at Dhaka Medical College Hospital. 

This led to violent clashes, with doctors being assaulted, emergency gates being locked, and armed individuals storming the hospital. The doctors suspended emergency services, only resuming after the government promised better security.

In December, postgraduate trainee doctors from private institutions staged protests demanding higher stipends, blocking roads and halting work until their demands were met in two phases. Other healthcare professionals also protested for promotions, better postings and reforms. 

The transition of power following the formation of the interim government also saw widespread changes across the Ministry of Health, hospitals, and medical colleges, further exacerbating the overall chaos in the sector.

Doctors previously affiliated with the Awami League's Swadhinata Chikitshak Parishad (Swachip) were gradually removed from key positions, replaced by BNP-affiliated Doctors' Association of Bangladesh (DAB) and the Jamaat-linked National Doctors' Forum (NDF) — often without regard for merit or expertise. Some transferred doctors were labelled "allies of tyranny," with threats of obstruction at their new workplaces.

At the bureaucratic level, leadership instability further paralysed the ministry. Frequent changes at the secretary level disrupted decision-making, leaving vital issues unresolved. The employment status of nearly 14,500 community clinic workers remained in limbo, with months of unpaid salaries creating further distress.

Amidst the turmoil, the health and safety of citizens have become the collateral damage. 

The failures of both the Awami League and the subsequent interim government to implement effective measures to control dengue, coupled with a lack of comprehensive action, remained a focal point of discussion throughout the past year. 

In the past seven months since the interim government took over, numerous allegations of deaths due to negligence in hospitals have also emerged, while the proper treatment of even those injured during the July Uprising in local hospitals remains a distant hope. 

At government hospitals, patients face long waits at ticket counters, delays in seeing doctors, and inefficiencies in test payments and report collection, often wasting days before receiving proper treatment.

As a consequence, public frustration continues to mount, with the country's healthcare system now grappling with an unprecedented crisis of confidence.

Experts stress that the frequent protests, which are bringing the sector to a standstill, signal the interim government's vulnerability under pressure. Another significant issue is the sector's continued politicisation, which has led to a vicious cycle of instability and inadequacy. Given these challenges, a better and more effective approach to reforming the healthcare sector is urgently needed.

Dr Shafiun Nahin Shimul, a professor of the Institute of Health Economics at Dhaka University, believes that instead of making hasty decisions, the interim government should have taken a more gradual approach. However, in the absence of such a strategy, they have created a perception that any demand could be met by taking to the streets, which is now difficult to break free from.

This pattern is not just limited to quickly giving in to protestors' demands. The government has also made sweeping changes without proper planning, which may come to haunt the healthcare sector in the coming years.

"You can't just move a doctor from, say, Dhaka to Barishal, without thinking about whether they will be able to perform their clinical duties effectively. Because of this, neither the doctor can deliver quality care in the new place, nor can their role be filled back in their previous location," he said.

According to Dr Shimul, this shows that even though healthcare is highly technical and sensitive compared to any other sector, the government failed to take this into account.

"For example, a doctor may very well be affiliated with the Awami League, but at the same time he might also be the only specialist in a hospital for a specific condition. Removing such a doctor without a suitable replacement only causes more harm. So instead of taking political decisions, the government should have taken a more thoughtful approach," he said.

Dr Shimul believes the government should now focus on getting the healthcare sector back to at least a "minimum functional level." Attacks on doctors need to stop, and patients must be given the care they need in hospitals. Once that is sorted, only then can trust be rebuilt with both the public and healthcare workers. After that, reforms can happen with input from the healthcare reform commission.

However, prior to that, the reform commission itself needs to be more diverse to ensure its effectiveness.

"The commission is currently made up exclusively of specialist physicians, but healthcare is a complex process that can't be solved by doctors alone. We need a combination of various experts, such as health economists, biomedical engineers, development workers, management professionals, and the like, to truly address the multifaceted challenges in the sector," Dr Shimul said.

Meanwhile, Dr Ahmed Mushtaque Raza Chowdhury, the convener of Bangladesh Health Watch and a professor at Columbia University's School of Public Health, pointed out that the healthcare system in the country is so politicised that it is nearly impossible for the interim government to fix things right away.

"Before, the sector was controlled by the Awami League, and now BNP-Jamaat-affiliated people have taken charge. With all that going on, the situation can't be turned around overnight," said Dr Chowdhury, also the former Vice Chair of BRAC.

Given these challenges, the best approach for the health reform commission would be to start with some less controversial issues that can be tackled within this interim government's tenure while laying the foundation for mid-term and long-term reforms.

Dr Chowdhury noted that with the interim government preparing to announce a budget, it is a great chance to increase funding for the healthcare sector. "To make universal health coverage a reality, the allocation for health should gradually rise to 2% of GDP," he said.

He emphasised the medicine issues as well. He explained that in Bangladesh, 69% of healthcare costs are borne by patients, with 65% of that spent on medicines. To reduce the burden of medicine costs, it is essential to increase the number of essential medicines in alignment with the World Health Organisation's list and based on local needs.

"The list should include medicines for the treatment of non-communicable diseases such as diabetes, hypertension, cancer, and respiratory diseases, and the supply of these medicines must be ensured for free distribution. In this context, strengthening the capacity of essential drug companies is a crucial condition," he said.

In the end, Dr Chowdhury also pushed for the formation of a permanent health commission and proposed several other reforms, such as the establishment of community-based GP clinics, the creation of an autonomous National Health Security Office, and extending the legal framework for regulating the private sector.